Pitfalls and clinical recommendations for the primary lumbar hernia based on a systematic review of the literature

Abstract

Purpose The lumbar abdominal wall hernia is a rare hernia in which abdominal contents protrude through a defect in the dorsal abdominal wall, which can be of iatrogenic, congenital, or traumatic origin. Two anatomical locations are known: the superior and the inferior lumbar triangle. The aim of this systematic review is to provide a clear overview of the existing literature and make practical clinical recommendations for proper diagnosis and treatment of the primary lumbar hernia. Methods The systematic review was conducted according to the PRISMA guidelines. A systematic search in PubMed, MEDLINE, and EMBASE was performed, and all studies reporting on primary lumbar hernias were included. No exclusion based on study design was performed. Data regarding incarceration, recurrence, complications, and surgical management were extracted. Results Out of 670 eligible articles, 14 were included and additional single case reports were analysed separately. The average quality of the included articles was 4.7 on the MINORS index (0–16). Risk factors are related to increased intra-abdominal pressure. CT scanning should be performed during pre-operative workup. Available evidence favours laparoscopic mesh reinforcement, saving open repair for larger defects. Incarceration was observed in 30.8% of the cases and 2.0% had a recurrence after surgical repair. Hematomas and seromas are common complications, but surgical site infections are relatively rare. Conclusion The high risks of incarceration in lumbar hernias demand a relatively fast elective repair. The use of a mesh is recommended, but the surgical approach should be tailored to individual patient characteristics and risk factors.

Abordaje laparoscópico de la Hernia de Grynfelt. Reporte de caso

“…El piso de este último triángulo lo forma la fascia transversalis y su raíz el músculo dorsal ancho. Una de las áreas de debilidad del triángulo superior se encuentra justo por debajo del reborde costal, donde la fascia transversalis no se une con la fascia del musculo oblicuo externo, como en el caso del paciente en mención (2,4,9).…”

“…Sin embargo, un estudio prospectivo publicado en el 2016 que compara la técnica abierta vs la técnica laparoscópica en un periodo de 14 años concluye que el abordaje laparoscópico es más efectivo que el abordaje abierto, con una tasa de recurrencia del 2.9% y que el abordaje abierto debería considerarse como opción solo para defectos mayores de 15 cm (4, 7). Por otra parte, en una revisión sistemática publicada más recientemente, concluyen que el abordaje laparoscópico preperitoneal es preferible en defectos pequeños (menores de 5 cm) y simples, a diferencia de defectos mayores que deben ser individualizados según las características del paciente; además, se plantea como alternativa el abordaje robótico transabdominal preperitoneal, pero se requieren más estudios para poder sugerir una recomendación (9).…”

Clinical, Surgical Characteristics and Long-Term Outcomes of Lumbar Hernia.

“…Low suspicion may lead to delayed diagnosis or misdiagnosis of other soft tissue lesions, such as subcutaneous lipoma, retroperitoneal tumor, abscesses, bromas or perirenal abscess [5,6]. Surgical treatment of lumbar hernias is essential because of risks of incarceration, strangulation and perforation [7][8][9], but surgical repair can be di cult considering the location of the hernia and the surrounding bony structures [1,10].…”

“…Previously, with only a few hundred of patients reported, lumbar hernias are extremely rare [9,11]. A hernia surgeon may only come across one case throughout their career in view of the rarity of lumbar hernia [11].…”

“…Up to now, there is little information about the clinical features, surgical treatment and postoperative follow-up of lumbar hernia. There is still ongoing discussion regarding which is the optimal surgical technique to be employed for lumbar hernias [9]. In the present study, we, therefore, investigated the clinical features, treatments, and long-term follow-up outcomes of lumbar hernias based on data obtained from 28 consecutive patients in our institution.…”